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Area of Science:

  • Anesthesiology
  • Pediatric Critical Care
  • Patient Safety Research

Background:

  • Pediatric anesthesia-related cardiac arrest (ARCA) is an uncommon, potentially preventable adverse event.
  • Infants and children with more severe underlying diseases face the highest risk of ARCA.
  • Identifying system- and anesthesiologist-related risk factors for ARCA is critical.

Purpose of the Study:

  • To identify system- and anesthesiologist-related risk factors for pediatric anesthesia-related cardiac arrest (ARCA).
  • To analyze the impact of patient severity and anesthesiologist experience on ARCA risk.

Main Methods:

  • Analysis of a prospectively collected cohort of pediatric anesthetics administered between 2000 and 2011.
  • Characterization of pre-procedure systemic disease using ASA physical status (ASA-PS).
  • Independent review of cardiac arrests to determine anesthesia relatedness and reevaluation of factors after adjustment for patient age and ASA-PS.

Main Results:

  • Cardiac arrest occurred in 5.1/10,000 anesthetics; 2.6/10,000 were anesthesia-related.
  • Univariate analysis showed higher ARCA risk associated with cardiac patients, lower anesthesiologist caseload, and fewer annual anesthesia days.
  • After risk adjustment, only fewer annual anesthesia days remained a significant risk factor for ARCA (P=0.03).

Conclusions:

  • Patient case-mix explained most associations between ARCA risk and anesthesiologist variables.
  • Fewer annual days delivering anesthetics remained a significant independent risk factor for pediatric ARCA.
  • Findings underscore the necessity of rigorous adjustment for patient risk factors in anesthesia patient safety research.